The *other* 4 letter word: ITBS

Okay, okay: technically ITBS is not a word. But, I can use a four letter word to describe how completely frustrating this condition is.

In the past several weeks, I’ve talked with quite a few people on Twitter, Facebook and in the flesh about their trials with ITBS – otherwise known as iliotibial band syndrome. The sad fact is that if you are a runner, you are very likely to get at least a minor bout of ITBS at some point in your running career. In fact, ITBS is one of the leading causes of lateral knee pain among runners.

I had my first experience with ITBS two years ago, after running my first 50k ultramarathon. For weeks, I had stinging pain on the outside of my right knee, which came a result of an inflamed ITB as it rubbed over the lateral epicondyle (see picture at right). Since then, I’ve battled off and on with recurring bouts of this issue. (For a list of various symptoms and causes, click here or here.)

In the past several months, I took more serious measures beyond the wait-and-see approach, and it’s made a world of difference for my health. I’ve learned several valuable lessons that I would like to share with those of you who also suffer from ITBS.

These tips are also useful to anyone with all types of tendonitis and soft tissue injuries (or “issues” as I like to call them). And, if you are into prevention – these tips are also good for you.

Know when to stop

First and foremost, if you feel pain, STOP RUNNING (or cycling, or swimming as the case may be). ITBS or tendonitis is not something that you can just run through, and once you “loosen up,” you’ll be okay. Yeah, I told myself that lie for about 8 months as I limped through training runs–and races. Guess what? Doesn’t work. If you take a short break now, it may prevent an extended break later.

Don’t just sit there – be proactive

Rather than sit and wait for the problem to heal itself while you rest, be proactive. Find a sports doctor to help identify the trigger for the ITBS as well as the root cause of it. For me, the main activity (but not the only activity) that seems to trigger my ITBS is downhill running and climbing on the bike. After reviewing my logs, it seems that the hills leave me most vulnerable to a flare up. Furthermore, with the help of my sports chiroprator, Dr. Eric Nelson, we’ve determined that the root of my problem is a lazy butt, or weak gluteus muscles to be more precise. (I’ve written about this in a previous post, which you can find here.)

These issues were further exacerbated by a poor bike fit. So, for the triathletes reading this: if you haven’t had a bike fit in a while – get one. As an added bonus, I found some power due to increased efficiency after I was properly fit 🙂

Strength & Stretching

Once you identify the weakness that is causing the inflammation, put together a strength training regimen to address it. If you are similar to me and have a lazy butt, you can find some exercises here. (Note: many cases of ITBS come from weak glute muscles, so you are likely to have this problem.)

In addition to strength training, you should make stretching a regular part of your routine–before and after training sessions. I recommend dynamic stretches over static ones, particularly before your work out. If you are new to dynamic stretching, here’s a basic routine from Runner’s World: http://www.runnersworld.com/article/0,7120,s6-241-287–13442-0,00.html

Biomechanics

Most likely, strength and/or flexibility imbalances have also led to some biomechanical inefficiencies due to compensatory movement you’ve made over time. You’ll want to address those as well.

Ask someone to video you while you are running. If you have an iPhone or an Android, there is a pretty useful app for that. It’s called Coaches Eye. But, you don’t need this app in order to analyze your form. Have your doctor (or someone knowledgeable in gait analaysis) look at it. When Dr. Nelson looked at my video, he saw the hip drop immediately. Stronger glute muscles = less hip drop. That simple.

Once you identify any biomechanical quirks, gradually work on improving them. But, do so cautiously! Trying to change your form overnight can lead to a new set of injuries.

Oh, what a release it is!

Another important part of the equation for me has been a mixture of myofascial release strategies, including Active Release Technique, Graston Technique, deep tissue massage, and foam rolling. The first three strategies will require the help of a professional. For ART or Graston, you can find a provider by going to the links above. I recommend trying to find a single provider who does both, as Dr. Nelson does. In this manner, your care is centrally managed. Be forewarned: Graston hurts like HE!! and it may cause some bruising (very minimal in my case) – but it works. Just remember to breathe into it.

In the case of a massage, I recommend asking other athletes who they use. If you are within 20-30 miles of Atlantic City, NJ, I have a great recommendation for you. Patti is a magician!  (She doesn’t have a website, so if you want her contact info, just email me – mariaismaslife@gmail.com). Otherwise, use the web to do some research and ask around.

For all of these strategies, you will want to find a provider who offers sports-specific care. My rule: if you aren’t athlete (or weren’t at some point), you aren’t touching me.

Foam rolling you can do to yourself. (Get your mind out of the gutter!!) If you don’t have a foam roller, get one right now. Stop reading my blog, and purchase one. Then, go to YouTube and watch any of the myriad of videos they have there for using a foam roller.

Here’s one of my favorites:

The combination of all of these measures has led to several months of pain-free running–and some of the best training runs I’ve had in over a year. My racing season will start in just a few short weeks,which will be the ultimate test, but for now, I am optimistic that I’ll be running pain-free for the 2012 season. (Much to the chagrin of the company that makes Alieve.)

I hope these tips for managing your ITBS (and other types of tendonitis) are useful. If you have additional ones, please share! We will all benefit.

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